Information Collection

Parent Questionnaire

IC 237376 under ICR 201908-0930-005 · OMB 0930-0385.

Documents and Forms

Document Name Document Type
Form Parent Questionnai Parent Questionnaire Form and Instruction
Parent Questionnai Parent Questionnaire Questionnaire_TTHY_073019_FINAL 081519.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Parent Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Parent Questionnaire	Parent Questionnaire	Questionnaire_TTHY_073019_FINAL 081519.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30,000	30,000
Annual IC Time Burden (Hours)	2,100	2,100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.